Jagielski Janusz, Kubiczek-Jagielska Marzena, Sobstyl Michał, Koziara Henryk, Błaszczyk Janusz, Zabek Mirosław, Zaleski Marek
Klinika Neurochirurgii, CMKP, ul. Kondratowicza 8, 03-232 Warszawa.
Neurol Neurochir Pol. 2006 Mar-Apr;40(2):127-33.
In advanced stages of Parkinson's disease (PD) beside resting tremor, rigidity, and bradykinesia, most patients reveal severe balance instability. The goal of this study is to determine objectively postural control changes using static posturography after neurosurgical treatment (unilateral posteroventrolateral pallidotomy).
15 patients with advanced idiopathic PD underwent unilateral posteroventrolateral pallidotomy. The study group was composed of 8 men and 7 women. The mean disease duration until operation was 12.5+/-3.5 years, and the mean age of the patients at the time of surgery was 65.8+/-4.1 years. Postural control changes were assessed objectively by static computerized posturography and subjectively according to items of posture, gait and postural stability derived from Part III (motor examination) UPDRS. All evaluations of the balance system were performed preoperatively in the off and on condition, and also two weeks postoperatively in the same conditions.
It was found that the majority of posturographic parameters in the off condition were improved after neurosurgical treatment. The improvement in the on condition was less pronounced. For example, the mean path length in the off condition during eyes opened was 318+/-159 mm before pallidotomy, and after surgery it was 240.9+/-119.2 mm in off. The difference was statistically significant (p < 0.005, t=3.11).
Pallidotomy improves postural control changes in the early postoperative period, which can be proved by static computerized posturography.
在帕金森病（PD）晚期，除静止性震颤、强直和运动迟缓外，大多数患者还表现出严重的平衡不稳。本研究的目的是通过神经外科治疗（单侧后腹侧苍白球切开术）后使用静态姿势描记法客观地确定姿势控制的变化。
15例晚期特发性PD患者接受了单侧后腹侧苍白球切开术。研究组由8名男性和7名女性组成。手术前的平均病程为12.5±3.5年，手术时患者的平均年龄为65.8±4.1岁。通过静态计算机化姿势描记法客观评估姿势控制变化，并根据源自第三部分（运动检查）统一帕金森病评定量表（UPDRS）的姿势、步态和姿势稳定性项目进行主观评估。平衡系统的所有评估均在术前“关”和“开”状态下进行，术后两周也在相同状态下进行。
发现神经外科治疗后，大多数“关”状态下的姿势描记参数得到改善。“开”状态下的改善不太明显。例如，苍白球切开术前，睁眼时“关”状态下的平均路径长度为318±159mm，术后“关”状态下为240.9±119.2mm。差异具有统计学意义（p<0.005，t=3.11）。
苍白球切开术可改善术后早期的姿势控制变化，这可通过静态计算机化姿势描记法得到证实。
